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Estimation of body surface area in neonates, infants, and children using body weight alone
Ranaa Akkawi El Edelbi1,2, Synnöve Lindemalm2,3, Per Nydert2,3
1Department of Women's and Children's Health, Childhood Cancer Research Unit, Karolinska Institutet, Stockholm, Sweden.
Insights
A new Meeh-type equation accurately estimates Body Surface Area (BSA) in children aged 0-18 years without height, simplifying drug dosing. This method offers high precision and accuracy for pediatric patients.
Area of Science:
- Pediatric Medicine
- Biostatistics
- Pharmacokinetics
Background:
- Accurate Body Surface Area (BSA) calculation is crucial for pediatric drug dosing.
- The Mosteller equation, using height and weight, is the current standard but requires height measurement.
- New equations estimating BSA from weight alone are needed for efficiency.
Purpose of the Study:
- To develop and validate new equations for estimating pediatric Body Surface Area (BSA) using only Body Weight (BW).
- To compare the accuracy of novel BSA estimation equations against the established Mosteller equation.
- To assess the feasibility of using a weight-only BSA equation in clinical practice.
Main Methods:
- Utilized BSA data from 27,440 hospital visits (20,635 pediatric patients).
- Tested three nonlinear regression equations (polynomial, Meeh-type, Boyd-type) against Mosteller's BSA.
- Employed Spearman correlation, Sheiner-Beal bias/precision analysis, and Eksborg plots for validation.
Main Results:
- All tested equations showed high correlation with Mosteller's BSA (P < .0001).
- The Meeh-type equation demonstrated the best fit, with 99.2% of ratios within 0.9-1.1.
- Overestimation/underestimation by tested equations was minimal (0.06%–0.40%).
Conclusions:
- A single Meeh-type equation accurately predicts Mosteller's BSA in children (0-18 years) without height data.
- This weight-based BSA estimation offers high precision and accuracy for pediatric drug dosing.
- Integration into CPOE systems is planned to enhance pediatric medication safety.
Background:
The aim of this study was to use Body Surface Area (BSA) data calculated with the Mosteller equation to test potential new equations that estimate BSA using Body Weight (BW) alone in children aged 0-18 years.Mosteller's equation, the golden standard at our hospital, was used to calculate the BSA in infants and children aged 0-18 years using BW and height data from 27,440 hospital visits by 20,635 patients over one year.
Methods:
The best fit of three nonlinear regression equations (third-order polynomial, Meeh-type, and modified Boyd self-adjusting-type) to a plot of the calculated Mosteller BSA values versus BW was then investigated. The correlation between the BSA values estimated by these equations and the Mosteller BSA values was established by the Spearman rank correlation test. Bias and precision were evaluated as outlined by Sheiner and Beal. Measured and estimated BSA values were compared using the Eksborg plot.
Results:
The estimated BSA values from all three equations and the BSA values from the Mosteller equation were closely correlated (P < .0001). The third-order polynomial and Meeh-type equations overestimated BSA by 0.13% and 0.40%, respectively, while the Boyd self-adjusted-type equation underestimated BSA by 0.060%. For the entire pediatric population, the best fit was obtained with the Meeh-type equation: 99.2% of the Meeh/Mosteller BSA ratios were within the range of 0.9-1.1 when compared with 98.3% and 97.2% for the polynomial and Boyd-type equations, respectively.
Conclusion:
A single Meeh-type equation can be used to predict the results of Mosteller equation when H is not available with high precision and accuracy in children aged 0-18 years, including term neonates. We now plan to include the results of this study in CPOE systems in Sweden to improve drug dosage in all children.
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